Sbano Paolo, Rubegni Pietro, Risulo Massimiliano, De Nisi Maria Caterina, Fimiani Michele
Department of Clinical Medicine and Immunological Sciences, Section of Dermatology, University of Siena, Siena, Italy.
Int J Dermatol. 2007 Jul;46(7):720-1. doi: 10.1111/j.1365-4632.2007.03173.x.
A 36-year-old woman presented with chronic recurring dermatitis of the vulva, perineum, and lips. The genital lesions had a 3-year history and were associated with slight pruritus and occasional pain. The lesions of the upper lip had a history of 6 months. The patient had been treated with cycles of antimycotics and topical steroids which only partially controlled the symptoms during treatment. Dermatologic examination showed erythematous, infiltrative dermatitis with edema of the labia majora and persistent edema of the upper lip (Fig. 1a,b). Routine blood chemistry, urine analysis, and chest X-ray were normal. Microscopic examination and cultures of vaginal swabs did not reveal any pathogenic bacteria or fungi. Histologic examination of a biopsy of vulval lesional skin showed lichenoid lymphocytic infiltration of the papillary dermis and small, nonnecrotic epithelioid granulomas in the deep dermis (Fig. 1c,d). No microorganisms, including acid-fast bacilli or fungi, were identified. Culture was negative for fungi. Polymerase chain reaction was negative for the mycobacterial genome. Histologic examination of a biopsy from the upper lip showed similar results. The pathology reports of both regions were compatible with a diagnosis of granulomatous cheilitis and vulvitis. To investigate concomitant asymptomatic inflammatory bowel disease, the patient underwent colonoscopy with retrograde ileoscopy and gastroscopy, which were both negative. The patient refused radiographic examination of the small intestine with a barium meal. The patient was treated with systemic metronidazole (500 mg/day). After 6 months of therapy, the upper lip showed significant improvement and erythema and desquamation in the genital area showed slight improvement, but genital edema was unaffected.
一名36岁女性出现外阴、会阴和唇部慢性复发性皮炎。生殖器病变已有3年病史，伴有轻微瘙痒和偶尔疼痛。上唇病变有6个月病史。患者曾接受抗真菌药和外用类固醇治疗，治疗期间症状仅得到部分控制。皮肤科检查显示为红斑性浸润性皮炎，大阴唇水肿，上唇持续性水肿（图1a、b）。常规血液生化、尿液分析和胸部X线检查均正常。阴道拭子的显微镜检查和培养未发现任何病原菌或真菌。外阴病变皮肤活检的组织学检查显示乳头真皮层有苔藓样淋巴细胞浸润，真皮深层有小的、非坏死性上皮样肉芽肿（图1c、d）。未发现包括抗酸杆菌或真菌在内的微生物。真菌培养为阴性。聚合酶链反应检测结核分枝杆菌基因组为阴性。上唇活检的组织学检查结果相似。两个部位的病理报告均符合肉芽肿性唇炎和外阴炎的诊断。为了调查是否合并无症状性炎症性肠病，患者接受了结肠镜逆行回肠镜检查和胃镜检查，结果均为阴性。患者拒绝进行小肠钡餐造影检查。患者接受了全身甲硝唑治疗（500毫克/天）。治疗6个月后，上唇有显著改善，生殖器区域的红斑和脱屑有轻微改善，但生殖器水肿未受影响。
